A Lesson Learnt from a Dural Carotid Cavernous Fistula-induced Superior Ophthalmic Vein Occlusion with Posterior Ischaemic Optic Neuropathy

Hoang, Tung Thanh; Nguyen, Cao; Ha, Thanh Thien Huy; Subramanian, Prem S.

doi:10.1080/01658107.2021.2000622

Cited by 2 publications

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“…To our knowledge, there are only two reported cases of PION as an ophthalmic complication of dural CCF. 9 , 10 Hashimoto et al described a case of presumed unilateral PION in an ipsilateral posterior-drainage dural CCF, which was fed by dural branches from the ICA and ECA; however, no DWI and ADC maps for confirmation of the PION were undertaken. 9 Recently, Hoang et al reported a case of unilateral posterior-drainage dural CCF (fed by dural branches from the ICA and ECA) with ipsilateral PION.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Recently, Hoang et al reported a case of unilateral posterior-drainage dural CCF (fed by dural branches from the ICA and ECA) with ipsilateral PION. 10 The authors of both studies hypothesized that the PION was caused by arterial steal in the setting of posterior-drainage dural CCF, which shifted the arterial blood flow from the orbital to intracranial direction. In contrast, the dural CCFs in our patient involved the anterior drainage, which was confirmed on cerebral angiography.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Posterior Ischemic Optic Neuropathy Due to Bilateral Anterior-Drainage Dural Carotid-Cavernous Fistulas: A Case Report

Thammakumpee

Padungkiatsagul

Putthirangsiwong

et al. 2023

IMCRJ

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Purpose To report a case of bilateral posterior ischemic optic neuropathy (PION) due to bilateral anterior-drainage dural carotid-cavernous fistulas (CCFs). Case Description We report on a 62-year-old woman with a history of poorly controlled hypertension who presented with sudden bilateral visual loss and headache for 5 days. She denied a history of head trauma. On examination, her visual acuities were no light perception (NLP) with fixed pupils in both eyes. The ocular motility of both eyes was limited in all directions. Both eyelids were difficult to open. Anterior segment examination revealed bilateral chemosis and episcleral corkscrew vessels. Intraocular pressures were 45 and 48 mmHg in her right and left eyes, respectively. Gonioscopy revealed blood in Schlemm’s canal at the nasal angle of the right eye. Fundus examination showed slightly dilated and tortuous retinal veins with normal-appearing optic discs in both eyes. The cup-to-disc ratios were 0.3 bilaterally. Other neurological examinations were unremarkable. Magnetic resonance imaging demonstrated dilation of the bilateral superior ophthalmic veins (SOVs), and marked orbital and periorbital congestion bilaterally. However, there was no compression or stretching of the bilateral optic nerves. Diffusion restriction on diffusion-weighted imaging, with corresponding reduced apparent diffusion coefficient, in the entire bilateral orbital segment of the optic nerves was revealed, consistent with bilateral PION. Magnetic resonance angiography revealed arterialization of the bilateral cavernous sinuses and SOVs. Cerebral angiography confirmed the diagnosis of bilateral anterior-drainage dural CCFs. Treatment with transvenous coil embolization was successful. Three months after embolization, ophthalmic examination demonstrated progressive improvement of aforementioned ophthalmic signs; however, her visual acuities remained NLP in both eyes. Conclusion To our knowledge, this is the first reported case of bilateral PION due to bilateral anterior-drainage dural CCFs. In spite of its rarity, PION should be considered as a severe, irreversible ophthalmic complication of anterior-drainage dural CCF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%